This is not directly writing-related, but it’s on my mind at the moment and something I seem to have had a bizarre amount of experience with.

As I write this, my grandpa has chosen to die. He’s 85 years old, was recently hospitalized with congestive heart failure and put on 24/7 oxygen, and he’s decided that’s it. A couple years ago he played tennis three times a week and went to the pool hall the other two days a week. But in recent years, with increased medications and decreased mobility, he’s been slowly losing his independence. He’s married, so he’ll be leaving behind his wife, which is difficult. And the rest of his family, of course. But it makes sense to me.

When the quality of the life you’re trying to maintain has slipped to the point where you’re basically just marking time and can’t function independently (he’s also experiencing macular degeneration, so who knows how much longer he’d have to drive himself around or read or watch TV), I understand wanting to let go.

Six years ago my mother was told that she needed open heart surgery to repair her mitral valve and replace her aortic valve. Without that surgery she probably had less than six months to live. Initially she decided not to have the surgery. She was in her mid-50’s, also married, and generally fully functional otherwise.

That decision didn’t make sense to me.

Sure, it’s not a pleasant surgery. (And if my mother ever reads this she’ll probably have some words to say about my description of that surgery as “not a pleasant surgery.” She might use words like “hell on earth” and “sheer torture.”) (The truth probably lies somewhere between those two extremes.)

But in her case it was a surgery that was going to be difficult for a limited period of time and then lead to an improved standard of living. It was fixing something in her that wasn’t working well.

(Again, my mom still has a different perspective on this. She’s on a number of medications now as a result of the surgery and had to change her diet due to those medications and the doctor’s recommendations of what would be good for her. So, the surgery irrevocably altered her life and she’s not happy about that. Never will be.)

She could have chosen to die by not having the surgery. She almost did. But, to me (and these are such personal decisions it’s hard to judge anyone else’s choice), choosing not to have that surgery would have been quitting.

Now, I am highly biased in this area because I watched my father make difficult choices for eighteen years. I’ve written about this some before, but for anyone who doesn’t want to track any of that down, the short summary is: My dad got strep throat when he was very young. It permanently damaged his kidneys. He was told he’d die when he rejected them because he couldn’t afford dialysis and there was no government funding at the time.

He did lose his kidneys. Thankfully, the government paid for most of his dialysis. He had a transplant (back in the days when they were still experimenting with how to make that happen – think prednisone at doses about twenty times what they’d give today that made him gain 100 pounds). The transplant failed after a year. He had another transplant. He got pneumonia while in the hospital and on immunosuppresants. It cost him one lobe of his lungs, the new kidney, and made him allergic to a whole class of antibiotics. So, back to dialysis.

That was all before I was six, so I don’t remember it. I do remember the numerous surgeries that followed, including two spinal fusions, and the daily choice he had to make to keep living, to keep dialyzing three times a week, to deal with the pain from bones that were dissolving due to long-term dialysis.

He chose to live all those years because he had a wife he loved and children he wanted to see graduate high school and go to college. (He loved us, too.)

By the time I was a freshman in college, my dad was divorced. He was in his final semester of college. My brother was playing sports at a four-year college. I was majoring in something or other at Rice. Everything he would’ve wanted to accomplish he had. And then they told him that the next surgery they needed to do was to put a rod through all of his cervical vertebrae and that he’d have to wear a steel halo for six months. Both my brother and I offered to leave school to care for him.

And that was finally enough for him. He went in to dialyze one day, but couldn’t because of low blood pressure. They hospitalized him and within a week he was dead.

On the kitchen table was his eulogy.

I don’t know that he chose to die so much as chose to quit fighting to live every day. But it made sense to me. (I’m not religious, but he was, and that was the first time that he was in the hospital that I didn’t pray for him.)

Each person draws that line of when to die differently. And it’s sometimes hard to judge from the outside whether they’re drawing it too close or too far. There are so many variables at play: age, relationships, attitude toward life, religion, ability to handle setbacks, pain threshold. (I’m sure there are more that I’m just not thinking of.)

I try to respect other’s decisions, even when I disagree with them, because I don’t have to live that person’s life. They do.

(But I can tell you when my mom decided not to have that surgery, I did make at least one impassioned plea for her to change her mind. I may have even resorted to a little emotional blackmail: “I’ve already lost one parent, don’t make me lose the other…” Us writers are nothing if not good at using our words.)

To me, choosing how and when to die (assuming it’s possible to do so) is one of the most personal choices in someone’s life and, to the extent I can honor that choice, I will.

(Of course, it’s never that simple, is it? I can think of at least a handful of people who were suicidal whose right to choose to die meant not a thing to me, because, in my outsider’s limited view, they needed medication and/or counseling rather than death. Then again, with my father’s example before me, I’m the fight until you can’t fight any more type. Although, if my life ever becomes sitting in a chair staring out a window all day because I can’t move and don’t have the energy to do anything, that’ll be the day I call it, too.)

So, anyway. For my grandpa’s sake, I hope that now that he’s made his decision the end is quick and painless. It’s never easy to lose someone you love, but sometimes we have to acknowledge that wanting them to stay is a selfish act on our part and that if we truly love them we have to let them go.

7 Responses to Choosing to Die

Excellent post. I have had several relatives myself with congestive heart failure and it can be a terrible, long drawn out process that is neither pleasant for the individual nor pleasant for those left to care for them. Unfortunately it isn’t curable and can only be managed up to a point, the end of course is inevitable, it’s really just a matter of how long. My sympathies are with you coming to terms with such a personal decision as one’s choice to die. Stay strong and be there for your grandfather every step of the way. This will be the greatest help that you can give him.

I wept when I read your post. My precious daughter, aged 38, died 83 days ago after battling a terrible disease and doctor error all her life. Vic was diagnosed with Osteogenesis Imperfecta at the age of 18 months. The prognoses were that she would not live to the age of 12…For 38 years I fought with doctors, and hospitals trying to keep her alive. I made “deals” with God, I fed her horrible food because it was “good for her”. She had 81 operations in her life. A year ago she said “Mommy, no more” My fight for her life lead to an immeasurable suffering on her part.

If I had my life over I would have only asked for His Grace to endure and accept His plan…

I’m so sorry for your loss. Being that close to that type of a situation is something that few can understand. And even those have been through something similar still can’t understand what your situation must have been like for you.

I hope that in time you’ll see that your fighting for her life also brought her some wonderful experiences that she wouldn’t have had otherwise. (And I hope that’s in fact true.) Hold on through this period – it’s when all the pain is so raw it can overwhelm you.

And it sounds like you do believe in God, so I would also urge you to pray to him and remember that she’s now safe with him. And that, at least the God my father knew, is a forgiving God. Don’t punish yourself for the decisions you made out of love.

I wish I could say something more to help you through this…

Stay strong. And feel free to reach out if you ever find yourself in too dark a place.

My grandmother lost the will to live after her husband passed away. She slowly starved herself and nine months later died herself.

I just found out this week that my dad is very sick with what I thought was stage 4 hopkins lymphoma cancer. Now, they’re not so sure. It’s hard to imaging that 5 years ago he was running marathons and now he’s unable to walk. My parents had their first civil conversation in 15 years and it really broke me to hear my mom crying to me on the phone because my dad begged her to get my brother to see him once more…I haven’t seen him yet because I live so far away, but I’ll be there in two weeks. I can’t bear to talk to him on the phone even because from everyone else I’ve talked to it sounds like he’s just wants to say goodbye and he’s not hopeful for anything else.

I don’t want to question anyone’s choice whether or not to fight until their last breath. But I do understand how hard it is to watch that person from the sidelines make the decision. It just sucks.

So sorry to hear that Lizzy. That really does suck. And it has to be that much more difficult when you’re not there and your father was so healthy before. I hope your brother, for his own sake, does decide to see him one last time. Even if it’s an awful experience (I don’t know their history) he’ll at least know he tried.

And I hope you make it back in time to see him. I hate having seen my dad’s final moments, but I think I’d hate it more if I hadn’t made it back to say goodbye. (Because I wouldn’t have known and I would’ve always wondered.)